Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions

Area of Science:

• Pediatric Bone Health
• Medical Imaging
• Skeletal Physiology

Background:

• The 2007 International Society for Clinical Densitometry (ISCD) guidelines excluded children under 5 years for skeletal health assessment.
• Advancing clinical care for very young children necessitates evaluating dual-energy X-ray absorptiometry (DXA) methods for this age group.

Purpose of the Study:

• To review and recommend appropriate methods and skeletal sites for DXA measurements in infants and young children (0-5 years).
• To determine how DXA results should be reported for this pediatric population.

Main Methods:

• Literature review of studies addressing DXA methodology, skeletal sites, and reporting for infants and young children.
• Evaluation of feasibility and reproducibility of DXA measurements in children under 5 years.

Main Results:

• DXA whole-body bone mineral content and density are feasible and reproducible for children aged 3 years and older.
• DXA lumbar spine measurements are feasible and reproducible for infants and young children aged 0-5 years.
• Insufficient data exists for forearm and femur DXA measurements, and methods for interpreting results considering growth delay are unknown.

Conclusions:

• Current evidence supports DXA whole-body and lumbar spine measurements in young children, but further research is required.
• Development of reference data for children 0-5 years across multiple skeletal sites is crucial for accurate DXA interpretation.
• Existing ISCD positions on skeletal health assessment for this age group are likely to evolve with new data.